Comprehensive Preventive Dentistry E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1253

Veröffentlichungsjahr: 2012

Beschreibung

Comprehensive Preventive Dentistry provides one user-friendly resource that brings together information on the scientific basis and clinical practice of all aspects of preventive dentistry. This thorough and all-encompassing resource offers techniques and strategies for maintaining excellent oral health in patients through a regimen of preventive measures. Comprehensive Preventive Dentistry is grounded in a patient-centered, pre-emptive, and minimally invasive philosophy. The book begins by covering individual diseases, such as caries, periodontitis, and oral cancer, as well as therapies (sealants, fluoride) and other relevant conditions (toothwear, hypersensitivity). Additionally, concepts such as the role of diet and nutrition in oral health are discussed. Also covered are oral care products and new techological developments in caries diagnosis and risk assessment, periodontal disease and oral cancer, as well as new developments in home care products. A valuable and comprehensive companion that will appeal to dentists and dental hygienists, this helpful new book provides its readers with one authoritative resource that offers a reliable and helpful companion to practicing preventive dentistry.

Leseprobe

Contents

List of Contributors

Preface

Who should read this book?

What is preventive dentistry?

Client versus patient

Is preventive dentistry still needed?

Acknowledgments

1 A brief introduction to oral diseases: caries, periodontal disease, and oral cancer

Introduction

The global burden of oral diseases

Dental decay (dental caries): global patterns

Caries prevention: how far we have come in one century!

An introduction to dental decay

Caries as an infectious disease

The role of saliva

The role of dietary sugars

Plaque biofilms and their role in caries and periodontal disease

The demineralization–remineralization balance in caries

Coronal versus root caries

Current patterns of periodontal disease

Caries versus periodontal disease

Periodontal disease etiology

The pathogenesis of gingivitis

The pathogenesis of periodontal disease

Oral cancer

Why do people get dental decay, periodontal disease, and cancer?

Smoking: an addiction that increases the risk for all three dental diseases

Can dental professionals prevent oral diseases before they occur?

Final remarks

2 Caries detection and diagnosis

Summary of chapter

Introduction

Detection systems based on purely visual examinations

Detection systems based on electrical current measurement

Electronic Caries Monitor (ECM)

Radiographic techniques

Enhanced visual techniques

Fluorescent techniques

Laser fluorescence—DIAGNOdent

Photo-thermal Radiometry (PTR)

Other optical techniques

Ultrasound techniques

Conclusion

3 Diagnosis of periodontal diseases

The healthy periodontium

Gingivitis and soft tissue inflammation

Periodontitis and its progression

Dental calculus

New technologies in detecting periodontal disease progression

4 Oral cancer

Introduction

Epidemiology of oral cancer

Risk factors

Premalignant or potentially malignant oral lesions

Early diagnosis of oral cancer

Screening for oral cancer

Role of the dental team

5 Evidence-based dentistry

Introduction

Epidemiology

Study designs in epidemiologic studies and their analytical framework

Main types of epidemiological studies

Conclusions

Acknowledgement

6 The role of diet in the prevention of dental diseases

Introduction

The impact of dental diseases on well being

The systemic effect of nutrition on the teeth

Population studies

Human intervention studies

Observational studies of sugars and dental caries

Which is more important—frequency of sugars consumption or the amount of sugars consumed?

Does the cariogenicity of different types of sugar differ?

Does reducing sugars intake remain important when a population is exposed to fluoride?

Does starch cause dental caries?

Does fruit cause dental caries?

Classification of sugars for dental health and general health purposes

Strategies to prevent dental caries: modification of free sugars consumption

What are the current recommendations for levels of sugars intake in different countries?

What research is required to advance knowledge in the field of nutrition and oral health?

7 Probiotics and dental caries risk

Introduction

Caries-related mechanisms of probiotic activity

Probiotics and counts of mutans streptococci

Probiotics and caries occurrence

Other than caries-related effects of probiotics on oral health

Conclusions

8 Mechanical plaque removal

Introduction: why remove oral biofilm?

The toothbrush

Toothpaste

Interdental cleaning aids

The trouble with meta-analysis in dentistry

Brushing time

How best to teach brushing

Fixed prosthesis biofilm removal

Toothbrushing methods

Cleaning the tongue

Dental floss

Mouthwashes and mouth rinses

Conclusion

9 The role of sugar alcohols, xylitol, and chewing gum in preventing dental diseases

Introduction

Dental caries, sugar alcohols, and xylitol

Chewing gum in the control of dental caries

10 Preventing dental disease with chlorhexidine

Introduction

Chlorhexidine in the current armamentarium of the dental professional

The pharmacology of chlorhexidine

Oral dosage forms of chlorhexidine

Chlorhexidine and fluoride

Chlorhexidine mouth rinses for plaque and gingivitis control

Alternatives to chlorhexidine mouth rinses for controlling plaque and gingivitis

Chlorhexidine and caries prevention

New developments in chlorhexidine varnish technology

The Prevora antibacterial tooth coating

The therapeutic indication of Prevora—prevention of caries in high-risk adults

The efficacy and safety of Prevora

Other evidence of Prevora’s preventive effect in other high risk populations

The context for considering chlorhexidine products for caries management

The prospects for continued innovation in chlorhexidine products and in more preventive dental care

Overall conclusions

Editor’s disclosure

11 Ozone in the prevention of dental diseases

Introduction

Ozone: is it a disinfectant or medicine?

Mode of action of ozone

Effects of ozone on human health

Ozone dose calculations

Why ozone is safe to administer to most human tissues

Ozone use in medicine

Application of ozone in dentistry

Effect of ozone on oral microorganisms and oral cells

Ozone for disinfecting dentures

Ozone instruments designed for dentistry

Other ozone units used in dentistry

Ozone in the management of incipient caries

Ozone in the management of open caries

Treating root caries with ozone

Systematic reviews on ozone in clinical dentistry

Conclusion

12 Protection of the dentition

Sports dentistry and protective mouthguards

13 Tooth erosion

Introduction

Prevalence of the condition

14 The etiology, diagnosis, and management of dentin hypersensitivity

Introduction

Prevalence of dentin hypersensitivity

Etiology of dentin hypersensitivity

The mechanism involved in the etiology of dentin hypersensitivity

Treatment strategies to manage dentin hypersensitivity

Providing immediate relief in the dental office

Long-term therapy and home care

Additional home care products designed to treat dentin hypersensitivity

The application of ozone in the management of dentin hypersensitivity

Additional therapies not yet fully explored

The most common treatments used in clinical practice

Why it is so difficult to prove interventions can be successful?

Prevention strategies in avoiding dentin hypersensitivity

Conclusion

Disclaimer and conflict of interest statement

15 Caries risk assessment

Introduction

Dental caries—who is at risk?

Caries distribution

Treatment of dental caries

Modern caries management

Caries risk assessment

Risk assessment models

Selection of risk assessment instrument

Risk factors

Streptococcus mutans and lactobacilli

Other salivary factors

Fluoride exposure

Plaque

Fermentable carbohydrates

Previous caries experience

Sociodemographic indicators

Overall

Multifactorial caries risk assessment models

Cariogram

‘Caries risk and preventive needs assessment’ instrument

Summary

16 Fluoride therapy

Introduction

How fluoride works

Systemic fluoride

Water fluoridation

Fluoride supplements

Fluoridated salt

Fluoridated milk

Excess fluoride intake and dental fluorosis

Conclusion

17 Dental sealants

Introduction

Oral biofilm

Pit and fissure sealant: historical perspective

Introduction of resin-based pit and fissure sealants

Conclusions

18 Strategies for remineralization

Introduction

Light-activation of fluoride uptake

Caries prevention with light-activated fluoride

Factors that influence remineralization

Beta Tricalcium Phosphate (TCP)

Bioactive glass containing calcium sodium phosphosilicate (NovaMin™)

Unstabilized calcium and phosphate salts with sodium fluoride (Enamelon™)

Amorphous calcium phosphate

Dicalcium phosphate dehydrate

Other calcium compounds

Recaldent™ (CPP-ACP Nanocomplexes)

Treatment of white spot lesions

Disclosure

19 Oral health promotion in infants and preschool age children

Introduction

The most common oral problems encountered in young children

Prevention of oral problems

An effective model for oral health promotion in infants and young children using the ‘baby oral health: pregnancy through childhood’ video

Answering questions about oral health of infants and toddlers, most frequently asked by parents

20 High-risk patients: the frail older adult living in long-term care homes

Introduction: the need for better oral health care in long-term care

What Is long-term care?

Who resides in long-term care homes?

How are care and services provided in long-term care homes?

What is the status of oral health in long-term care?

Innovative oral care based on knowledge sharing

Oral health-related quality of life

Challenges for oral care professionals

A challenging case—how would you provide oral health services?

21 The effective preventive dental team

Introduction (compare this to original for formatting)

Preventive procedures in the dental office or for home use

Minimally invasive dentistry

Practice settings

Integrating preventive dentistry into a general practice

Conclusion

Acknowledgements

22 The independent dental hygienist

Introduction

Regulation

Registration

Complaints and discipline

How is dental hygiene legislation and prevention of oral disease connected?

Anti-competition

Choosing a practice setting

Working for yourself

Going it alone: advantages and challenges faced by dental hygienists who choose to operate their own businesses

Why do dental hygienists want to open their own business?

What are the advantages to the client in being treated directly by the dental hygienist?

Surely there are also disadvantages to the client?

Words of advice from dental hygienists who have chosen to “go it alone”

Points to consider

Reflections

Success stories

Acknowledgments

Index

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Library of Congress Cataloging-in-Publication Data

Comprehensive preventive dentistry / edited by Hardy Limeback. p. ; cm. Includes bibliographical references and index.

ISBN 978-0-8138-2168-9 (pbk. : alk. paper)I. Limeback, Hardy. [DNLM: 1. Tooth Diseases–prevention & control. 2. Comprehensive Dental Care–methods. 3. Preventive Dentistry–methods. 4. Tooth Diseases–diagnosis. WU 166] 617.6′3–dc23

2011050621

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List of Contributors

Editor

Hardy Limeback, BSc, PhD, DDSProfessor and Head, Preventive DentistryFaculty of Dentistry, University of TorontoToronto, Ontario, Canada

Contributors

Amir Azarpazhooh, DDS, MSc, PhD, FRCD(C)Assistant Professor, Faculty of DentistryDepartment of Biological and Diagnostic SciencesDiscipline of Dental Public HealthDepartment of Clinical SciencesDiscipline of EndodonticsUniversity of TorontoToronto, Ontario, CanadaDonna Bowes, RDH, BHADental SupervisorHalton Region’s Health DepartmentOakville, Ontario, CanadaGrace Bradley, DDS, MScAssociate ProfessorOral Pathology and Oral MedicineFaculty of DentistryUniversity of TorontoToronto, Ontario, CanadaAnn-Marie C. DePalma, CDA, RDH, MEd, FADIA, FAADHPrivate PracticeStoneham, Massachusetts, USAShirley Gutkowski, RDH, BSDHClinical Advisor American Association for Long Term Care NursingCross Link PresentationsSun Prairie, Wisconsin, USAW. Peter Holbrook, BDS, PhD, FDSRCSEProfessor, Faculty of OdontologyUniversity of IcelandReykjavík, IcelandFerne Kraglund DDS, MSc, FRCD(C)Assistant Professor, Dental Public HealthFaculty of DentistryDalhousie UniversityHalifax, Nova Scotia, CanadaGajanan Vishwanath (Kiran) Kulkarni, BDS, LLB, MSc, PhD, FRCD(C)Associate ProfessorPediatric and Preventive DentistryFaculty of DentistryToronto, Ontario, CanadaJim Yuan Lai, DMD, MSc(Perio), FRCD(C)Assistant Professor and Discipline Head, PeriodontologyFaculty of DentistryToronto, Ontario, CanadaIona Leong, BScHons, BDS., MSc, FRCD(C)Assistant ProfessorDepartment of Oral Pathology and Oral MedicineFaculty of DentistryUniversity of TorontoToronto, Ontario, CanadaDavid Locker, BDS, PhD, DSc, FCAHS (Deceased)Professor of Dental Public HealthFaculty of Dentistry, University of TorontoToronto, Ontario, CanadaKiet A. Ly, MD, MPHClinical Assistant ProfessorNorthwest Center to Reduce Oral Health DisparitiesDepartment of Oral Health SciencesUniversity of WashingtonSeattle, Washington, USAPeter Milgrom, DDSProfessor, Department of Oral Health SciencesAdjunct Professor of Pediatric Dentistry and Health ServicesNorthwest Center to Reduce Oral Health DisparitiesUniversity of WashingtonSeattle, Washington, USAPaula Moynihan, BSc, PhD, RPHNutr, SRDProfessor of Nutrition and Oral HealthInstitute for Ageing and HealthSchool of Dental SciencesNewcastle UniversityNewcastle Upon Tyne, United KingdomHien Ngo, BDS, MDS, PhD, FADI, FICD, FPFAProfessor and Chair of General Dental PracticeSchool of DentistryUniversity of QueenslandBrisbane, AustraliaRoss PerryPresident, CHX TechnologiesToronto, Ontario, CanadaIain A. Pretty, BDS(Hons), MSc, PhD, MFDSRCS (Ed)Professor of Public Health DentistryColgate Palmolive Dental Health UnitSchool of DentistryUniversity of Manchester Upon TyneManchester, United KingdomFran Richardson, RDH, BScD, MEd, MTSRegistrar/Chief Administrative OfficerCollege of Dental Hygienist of OntarioToronto, Ontario, CanadaColin Robinson, PhDProfessor Emeritus, Dental InstituteUniversity of LeedsLeeds, United KingdomW. Kim Seow, BDS (Adel), MDSc (Qld), PhD (Qld), DDSc (Qld), FRACDS, FICD, FADIProfessor and Director, Centre for Paediatric Dentistry Research and TrainingSchool of DentistryUniversity of QueenslandBrisbane, AustraliaPrakeshkumar S. Shah, MBBS (India), MD (India), MSc (Toronto), DCH (UK), MRCP (UK), FRCPCAssociate Professor, Department of PaediatricsUniversity of TorontoStaff Neonatologist, Mount Sinai HospitalToronto, Ontario, CanadaEva Söderling, MSc, PhDAdjunct Professor, Institute of DentistryUniversity of TurkuTurku, FinlandMary-Lou van der Horst, RN, BScN, MScN, MBAProject Consult Seniors HealthConestoga College-Research Institute for Aging-Schlegel Villages School of Health, Life Sciences and Community ServicesKitchener, Ontario, CanadaNursing and Knowledge Consultant in Older Adult Care Regional Geriatric Program - Central Hamilton Health Sciences - St. Peter’s Hospital - SJuravinski Reserach CentreHamilton, Ontario, CanadaLaurence J. Walsh, BDSc, PhD (Qld), DDSc (Qld), GCE d, FFOP(RCPA), FICD, FADI, FPFAProfessor and HeadSchool of Dentistry, University of QueenslandBrisbane, AustraliaList of Contributors

Preface

Who should read this book?

This textbook has been written for the practicing dentist, dental hygienist, dental assistant, and those students who aspire to enter the rewarding profession of dentistry. It is also meant to be a resource for dental educators. It is written in such a way that even patients interested in learning more about preventive dentistry should be able to easily understand this book: it is not a research text or complicated clinical manual. As with most clinical textbooks in dentistry, however, the current literature has been reviewed and cited. Each chapter discusses the current state of knowledge, with numerous practical suggestions for the private practice setting and discussions as to which products have been successfully used in preventive dentistry. A public health approach to managing dental disease in the population as a whole is occasionally mentioned in this book, but this is not its focus. Nevertheless, community dentistry students and Public Health Dentists would find this a useful text to learn about preventive procedures that might be adapted from the private practice setting to a public health setting. The main goal of the book is to bring to the reader new concepts not covered in other texts in dentistry and introduce the reader to new approaches to preventing dental diseases, especially dental caries.

What is preventive dentistry?

Preventive dentistry has its roots from the Latin terms ‘praevenire,’ which means ‘to anticipate’ and ‘dens,’ which is the word for tooth. Dentists and their team members strive every working day to ‘anticipate’ what could happen to their patients’ teeth and supporting structures. To predict whether a subject under observation will end up with damaged or diseased oral tissues, diagnosing the presence or absence of disease and then assessing risk for future disease, is required. These topics are discussed in Chapters 2 and 15, respectively.

In Chapter 1, the introduction chapter, we discuss the various levels of prevention. This book endeavors to review the best methods for primary prevention of dental disease: through primary prevention it is possible with intervention to ‘anticipate’ disease and prevent it altogether. Comprehensive preventive dentistry also includes intervening early, when the disease is just starting, and returning the subject to good health. This is secondary prevention. A new branch of dentistry has emerged called Minimal Intervention Dentistry, and some consider this to be part of preventive dentistry. Others, however, feel that this still represents restorative dentistry, but patients are treated using a more conservative approach, with minimal removal of tooth structure. True preventive dentistry means not having to remove ANY tooth structure. This book’s focus is to review the approaches that can be used before Minimal Intervention Dentistry is required.

There is actually very little evidence in the literature on what is really effective in protecting people from developing soft tissue diseases such as periodontal disease and oral cancer. Of course there are journals and texts in periodontics or oral pathology describing the management of these diseases once they develop. When an 8-mm periodontal pocket has formed, there has already been tissue damage. Similarly, when cancer is detected in the mouth and confirmed microscopically after a biopsy is taken, the cancer has already started. The cornerstone for the prevention of periodontal disease has been to control the biofilm that leads to tissue destruction. This can be achieved mechanically or with the aid of antimicrobials. To prevent oral cancer, alternatives to biopsies used for early detection and surgical removal are only now being explored. These include various molecular-based diagnostic markers. Since smoking is a risk factor for all oral diseases, smoking cessation education and motivation should be provided in each dental office. Dental insurance plans lag far behind new developments in providing preventive services, and it takes a long time for third-party insurers to recognize their values. Patients are not reimbursed for preventive services that would be considered ‘new.’ Thus, dentists are slow to adopt modern preventive services, especially in soft tissue disease prevention. It is not surprising, then, that this book’s primary focus is prevention of hard tissue destruction. It is what dentists have been most familiar with during the twentieth century. The new millennium will witness a massive expansion of products and techniques for the early detection and prevention of dental diseases.

Client versus patient

Because this book is written for the preventive dentistry team, dental hygienists will want to apply what they can learn from this book in clinical practice to treat their ‘clients.’ There is a trend in North America for the dental hygiene profession to refer to their patients as ‘clients.’ The reason being is that the term ‘patient’ is derived from the Latin verb ‘patior,’ meaning ‘I am suffering.’ For literally centuries health care providers have considered those who receive their services as ‘patients.’ But some people are in perfect health and are not ‘suffering’ from any illness or malady. These people seek the services of health care professionals to prevent illness. Although the term ‘client’ can be used to infer that the person is not ill or has any dental disease, it really is a term meant to describe a person involved in a business transaction receiving commerce goods and services. Lawyers, consultants, accountants, and hairdressers provide services to ‘clients.’ It may be an appropriate term for someone receiving ‘preventive dental care’ by a dental hygienist. Still, people accessing the services of most health care professionals prefer to be called ‘patients’ (Wing 1997).

To many in dentistry, it has become second nature for the dental hygiene profession to refer to those who receive their service as ‘clients.’ Within the same setting of a dental office with dentists and dental hygienists working together, the customer is sometimes called a client and sometimes called a patient. It would be ideal to have a term that everyone could be comfortable using.

Clinical researchers have traditionally avoided this relatively recent dichotomy of terms by calling the people in their clinical trials ‘subjects.’ This term is used throughout the book as well where appropriate.

Is preventive dentistry still needed?

As discussed in Chapters 1, 3, and 4, dental diseases are still widespread problems worldwide. Researchers have estimated the total expenditures on dental treatment and compared them to the costs of some medical diseases, and it might astound the reader to know that more money is spent in dentistry on treating patients than treating all cancer patients combined (Baldota and Leake 2004). The cost of treating patients with dental problems is only second to the cost associated with cardiovascular diseases. The cost of treating patients’ dental problems continues to increase annually. As decay rates decline, dentists turn their interest to previously underutilized therapies such as cosmetic dentistry, orthodontics, third molar extractions, implant dentistry, and so on. Despite approximately half of children growing up these days free of dental decay, there is still a huge demand for preventive dentistry. With more children undergoing orthodontics, there needs to be improved preventive care. People are keeping most of their teeth into old age and living longer, which means that preventing root caries, periodontal disease, and oral cancer will be even more important than before. The frail elderly is the fastest growing segment of the population, and they will need even more preventive care because of their increased risk for disease. We dedicate Chapter 19 to the frail elderly in the long-term care setting.

Although some dentists prefer to provide only cosmetic dentistry, or only orthodontics, most dental offices provide all-encompassing general dentistry services using teams to provide comprehensive preventive therapy. Dental hygienists and dental assistants are important members of the preventive team. The team approach is discussed in Chapter 21.

We have attempted to cover as many topics as possible in preventive dentistry in this textbook. I trust the title Comprehensive Preventive Dentistry best describes the contents of this book.

Dr. Hardy Limeback, BSc, PhD, DDSProfessor and Head, Preventive DentistryUniversity of Toronto

Baldota, K.K. and Leake, J.L. (2004). A macroeconomic review of dentistry in Canada in the 1990s. Journal of the Canadian Dental Association, 70, 604–609.

Wing, P.C. (1997). Patient of client? If in doubt, ask. Canadian Medical Association Journal, 157, 287–289.

Preface

Acknowledgments

This book started with a visit to our dental school in Toronto on May 7, 2008, by Sophia Joyce, Senior Commissioning Editor for dentistry books at Wiley-Blackwell in Oxford, UK. I was honored to be asked by such a well-known publisher of dentistry texts to edit a textbook. I was initially also assisted by Shelby Allen, Senior Editorial Assistant for Wiley-Blackwell in Ames, Iowa, and then Melissa Wahl, Wiley-Blackwell Editorial Assistant for Dentistry and Nursing in Ames, Iowa, who took over and provided me with expert guidance. Her cheerful emails and patience made the book editing process surprisingly pleasant.

This book is dedicated to my wife Lynne whose love, tolerance, and support made the project possible. I would like to thank my two sons for providing artistic direction. Many of the figures in my chapters were created by my youngest, Kevin, whose illustrations had visual beauty in their simplicity. My eldest son, Kurt, oversaw the design of the text front and back covers and provided crucial feedback throughout the whole process.

I could not have taken on this project without being a ‘wet-fingered’ dentist. For this, and for some of the clinical photos, I am grateful to my patients. My wife Lynne, my two loyal dental assistants Kellie and Tonia Bogle, and my part-time dental hygienists Susan Sung-Li and Samantha Campbell kept the dental office running while I spent all my spare time at the keyboard.

Several practicing dentists took the time to forward me clinical photographs for this textbook, and their contributions are gratefully recognized and noted throughout the text. By taking a 6-month sabbatical and relying on Assistant Professor Shaheen Husain in our department to take on some of my teaching duties, I was able to focus more on editing the text. I am particularly grateful to the preventive discipline’s administrative assistant, Bruna Valela, for taking on more duties while this text was being written.

I was honored by the willingness of recognized experts from far and wide with international reputations to provide full chapters for the book. We have authors from Finland, the UK, Iceland, Canada, the USA, and Australia. This text should therefore appeal to an international audience. These authors all lead such busy lives, but they gave their time generously to enhance the quality of this text. Without their contributions, I doubt this text would ever have been completed. Thank you very much chapter authors.

Hardy Limeback

1

A brief introduction to oral diseases: caries, periodontal disease, and oral cancer

Hardy Limeback, Jim Yuan Lai, Grace Bradley, and Colin Robinson

Introduction

By the late 1990s, treating dental disorders cost more than it did to treat mental disorders, digestive disorders, respiratory diseases, and cancer, at least in Canada (Leake 2006). The only group of disorders that exceeded dental treatment in terms of direct cost of illness was cardiovascular disorders (Leake 2006). In dealing with disease, “prevention is better than a cure.” Dental disorders are an enormous burden to society, especially when one now considers the connection between poor oral health and systemic illness, which is a topic that is becoming increasingly important and a focus of other scholarly books. Papananou and Behle (2009) describe the mechanisms linking periodontitis to systemic disease. Dentistry in the past has been treatment oriented, but we are witnessing an unprecedented interest in prevention. It is obviously better to prevent the disease in the first place, than treat it once it has taken hold. This is quite true for most diseases in medicine.

The three general disease categories of focus in dentistry are dental decay, periodontal disease, and oral cancer. In the case of oral cancer, associated with a high degree of mortality, preventive dentistry even saves lives. Figure 1-1 summarizes the general hierarchy of prevention in dentistry.

The goals of preventive dentistry are to avoid disease altogether. Maintaining a disease-free state (green) can result from primary prevention. When lifestyle changes are made early on, the risk for developing dental disease are minimized. Secondary prevention and early intervention (yellow) can be used to reverse the initiation of disease. An outcome of good health can still be achieved when incipient enamel lesions are reversed before cavities form, when gingivitis is reversed before periodontitis sets in, when dysplasia is found and excised before cancer develops, thus returning to good health and controlling dental disease is possible. Far too often though, dentists spend most of their time treating dental disease in an endless cycle of repeat restorations and surgery (red), which leads to tooth loss, and in the case of cancer, disfigurement and even death.

No one would disagree that it would be better to maintain oral health throughout life, never to have had any kind of dental disease. This is the goal of primary prevention (green area in Figure 1-1). Throughout the book we have used a ‘traffic light’ color system: “green is good,” “yellow means caution,” and red means “stop! fix the problem.” A similar theme has been used commercially in buffering capacity tests and in risk assessment (Ngo and Gaffney 2005).

Primary prevention for dental diseases such as dental caries and periodontal disease could include eating a healthy diet, maintaining low intake of fermentable carbohydrates, practicing meticulous oral hygiene throughout life, and reducing the other risk factors, such as smoking, that would normally lead to dental disease. In the case of oral cancer, primary prevention might include successful smoking cessation counseling, where a patient has been smoking for quite some time. Obviously it would be better for the patient not to have smoked at all.

Secondary prevention (‘caution’) suggests that the disease has started but can be reversed, and good health can still be achieved. For example, incipient carious lesions (white spot enamel lesions) can be arrested and reversed using appropriate ‘preventive’ measures so that a full-blown carious lesion never develops. It was well established that frequent oral hygiene reinforcement by dental professionals can prevent caries, gingivitis, and periodontal disease (Axelsson and Lindhe 1978).